CHAPTER THREE

RESEARCH DESIGN AND METHODS

3.1. STUDY DESIGN

The research will adopt a facility-based cross-sectional study design. This quantitative

approach is chosen to systematically assess the awareness and perception of exclusive

breastfeeding as a birth control method among pregnant women. A cross-sectional design is

appropriate for this study as it allows for the collection of data at a single point in time,

providing a snapshot of the prevalence of awareness and perceptions within the target

population. This design is efficient for describing the characteristics of the population and for

exploring associations between variables, such as demographic factors and the level of

awareness or perception, without inferring causality. The methodology will primarily rely on

structured questionnaires to gather self-reported data, which will then be analyzed using

statistical techniques to identify patterns and relationships.

3.2. STUDY SITE

The study will be conducted at the Gulbi Quarters Clinic, a key primary healthcare facility

situated within a designated rural community. This clinic was strategically selected due to its

representative patient demographic, which predominantly comprises women from

surrounding rural areas, providing a pertinent sample for understanding the local context of

maternal health and family planning perceptions. The Gulbi Quarters Clinic serves a diverse

population, characterized by its reliance on subsistence agriculture and local commerce,

which mirrors the broader socio-economic landscape of many rural settings. The facility's

operational structure, including its antenatal care services, makes it an ideal setting for

accessing the target population of pregnant women. The clinic's location and patient flow also
facilitate the logistical aspects of data collection, ensuring that a sufficient number of

participants can be engaged during the study period.

3.3. STUDY POPULATION

The study population will consist of pregnant women who are attending antenatal clinics at

the Gulbi Quarters Clinic during the designated study period. This specific population is

targeted because their current pregnancy status makes them a relevant group for

understanding perceptions and awareness related to birth control methods, particularly those

that may be considered post-delivery. Focusing on this group allows for the collection of pre-

delivery perspectives on exclusive breastfeeding as a birth control method, which can provide

valuable insights into existing knowledge and readiness for adopting such methods

postpartum. The selection of women attending antenatal clinics ensures that participants are

already engaged with healthcare services, potentially facilitating better recall and

understanding of health-related information, and are accessible within a structured clinical

environment.

3.4. SAMPLING TECHNIQUE, SAMPLE SIZE

3.4.1. Sample Size Determination

A minimum sample size of 384 was derived using the Cochran's formula, which is suitable

for estimating a proportion in a large population:

2
Z X p(1− p)
n=
d2

Where:

 n = desired sample size

 p = estimated prevalence of awareness of exclusive breastfeeding as a birth control

method. Based on similar studies in comparable rural settings, an estimated

prevalence of 50% (0.5) will be used in the absence of specific local data, as this

maximizes the sample size.

 d = margin of error (5% or 0.05)

Substituting the values:

Step 1: write the formula clearly

2
(1.96) × 0.5 ×(1−0.5)
n=
( 0.03)2

Step 2: perform the calculation inside the formula

3.841 × 0.25
n=
0.0025

Step 3: multiply the numerator

0.9604
¿
0.0025

Step 4: final results

n= 384.16

Therefore, a minimum sample size of 384 is required.

With a 10% non-response rate to account for incomplete questionnaires or refusals, the total

sample size will be:

Total Sample Size = 384 / (1 - 0.10) = 384 / 0.90 = 426.67

Thus, a total of approximately 427 pregnant women will be targeted for recruitment.

3.4.2. Sampling Procedure

sampling technique is particularly useful in clinical settings where a defined sampling frame

is often unavailable. The procedure involves recruiting all eligible pregnant women attending

the antenatal clinic at Gulbi Quarters Clinic who meet the inclusion criteria, one after another,

until the calculated sample size of 427 is achieved. This method ensures that every accessible

subject who fits the criteria is given the opportunity to participate, thereby minimizing

selection bias within the accessible population. Research assistants will be present at the

clinic during designated data collection days, approaching eligible women as they arrive for

their antenatal appointments. This systematic approach will continue over an estimated period

of [e.g., 4-6 weeks], depending on the clinic's average daily attendance, until the target

sample size is reached. If a potential participant declines to participate or does not meet the

criteria, the next eligible woman will be approached.

3.4.3. INCLUSION CRITERIA

 Pregnant women attending antenatal clinics at Gulbi Quarters Clinic.

 Women aged 18 years and above.

 Women who are able to understand and communicate in the local language or through

a trained interpreter.

 Women who provide informed consent to participate in the study.

3.4.4. EXCLUSION CRITERIA

 Pregnant women below 18 years of age.

 Women with severe medical conditions or complications that hinder their ability to

participate in an interview or provide reliable information.

 Women who are not permanent residents of the rural communities served by Gulbi

Quarters Clinic.
  Women who have cognitive impairments or mental health conditions that prevent

them from understanding the study or providing informed consent.

3.5. COLLECTION OF DATA, TOOL, AND PROCEDURE

Data collection will primarily be conducted through face-to-face interviews using a pre-

tested, structured questionnaire. The questionnaire will be designed in English and then

translated into the local language (e.g., Konkomba, Twi, Ewe and Nchunbro) and back-

translated to ensure accuracy and cultural appropriateness. It will comprise both closed ended

and open ended questions covering several key areas:

1. Socio-demographic Characteristics: Age, marital status, educational level,

occupation, parity, and household income.

2. Awareness of Exclusive Breastfeeding as a Birth Control Method (LAM):

Questions will assess participants' knowledge of the Lactational Amenorrhea Method

(LAM), including its mechanism, effectiveness, and the conditions under which it

functions (e.g., full or nearly full breastfeeding, amenorrhea, infant less than six

months old).

3. Perception of Exclusive Breastfeeding as a Birth Control Method: This section

will explore participants' attitudes, beliefs, and understanding regarding LAM. It will

delve into perceived benefits, drawbacks, reliability, and cultural acceptability of

using exclusive breastfeeding for birth spacing. A Likert scale (e.g., Strongly Disagree

to Strongly Agree) will be used for perception-related statements to capture the

nuances of their views.

4. Sources of Information: Questions will identify how women typically receive

information about family planning, birth control, and breastfeeding practices (e.g.,

health workers, family, friends, media).

10% of the sample size) of pregnant women from a similar rural health facility not included

in the main study site. This will help identify any ambiguities, ensure clarity of questions, and

refine the tool for optimal data collection.

Research assistants, with a background in public health and proficient in both English and the

local language, will be recruited and undergo rigorous training. The training will cover the

study objectives, detailed explanation of each questionnaire item, ethical considerations,

informed consent procedures, interviewing techniques, and proper data recording. The

principal investigator will oversee the entire data collection process, conducting daily reviews

of completed questionnaires to ensure completeness, consistency, and accuracy. Interviews

will be conducted in a private, quiet area within the clinic premises to ensure confidentiality

and minimize interruptions. Each interview is expected to last approximately 20-30 minutes.

3.6. ETHICAL CLEARANCE AND HUMAN ISSUES

Ethical clearance for the study will be obtained from the [Specify name of relevant Ethical

Review Board, e.g., Ghana Health Service Ethical Review Board or the University of Ghana

College of Health Sciences Ethical Review Committee]. Following ethical approval, formal

permission will be sought from the Ketu South Municipal Health Directorate and the medical

superintendent of the Gulbi Quarters Clinic. An introductory letter from the [Specify

department/institution, e.g., Head of Department, School of Public Health] will accompany

these requests.

Prior to participation, all eligible pregnant women will be provided with comprehensive

information about the study's purpose, procedures, potential risks, and benefits in a language

they understand. Informed consent will be obtained through a written consent form, signed or

thumb-printed by each participant. Participants will be explicitly informed that their

they can withdraw from the study at any point without penalty or affecting their access to

clinical services.

To ensure privacy and confidentiality, participants' names will not be recorded on the

questionnaires. Instead, unique numerical codes will be assigned to each participant.

Interviews will be conducted in a secluded space to guarantee privacy. All collected data will

be stored securely in password-protected electronic files and locked cabinets. Only the

research team will have access to the raw data, and all findings will be reported in an

aggregated format to prevent the identification of individual participants. The principle of

"Depiction is not Endorsement" will be strictly adhered to, ensuring that the study's objective

is solely to depict and understand perceptions without promoting any specific viewpoint.

While direct financial compensation will not be provided, participants may be offered a small

token of appreciation, such as refreshments, for their time and cooperation. The study

anticipates minimal risks, primarily related to potential discomfort from discussing sensitive

topics, which will be managed through sensitive interviewing techniques and ensuring a

respectful environment.

3.7. DATA PROCESSING AND ANALYSIS STRATEGIES

The data collected from the questionnaires will undergo a meticulous process of cleaning,

entry, and analysis. Initially, all completed questionnaires will be thoroughly reviewed

manually for completeness, legibility, and consistency by the research team. Any ambiguous

or incomplete responses will be flagged and clarified if possible, or excluded if clarification is

not feasible. The data will then be entered into a customized data entry form developed in

Microsoft Excel (Windows 10). To minimize data entry errors, double-entry verification will

be employed, where a second person independently enters a subset of the data, and
discrepancies are resolved. Random frequency checks will also be performed on various

variables to identify outliers and ensure data accuracy.

Once the data is cleaned and verified, it will be exported to STATA software (version 15 or

later) for statistical analysis. The analytical strategy will involve both descriptive and

inferential statistics:

 Descriptive Statistics: Frequencies and percentages will be used to summarize

categorical variables such as socio-demographic characteristics (age groups,

education, marital status, occupation, parity), levels of awareness, and perceptions of

exclusive breastfeeding as a birth control method. Means and standard deviations will

be calculated for continuous variables, if applicable.

 Inferential Statistics:

o Bivariate Analysis: Chi-square tests of independence will be conducted to assess the

association between categorical independent variables (e.g., educational level, parity, age

groups) and the dependent variables (awareness of LAM and perception of LAM).

Variables showing a statistically significant association (p < 0.05) in the bivariate analysis

will be considered for inclusion in multivariate models.

o Multivariate Analysis: Binary logistic regression will be performed to determine the

independent predictors of awareness and positive perception of exclusive breastfeeding as

a birth control method. Both crude Odds Ratios (OR) and Adjusted Odds Ratios (AOR)

with their 95% confidence intervals will be calculated and reported. This will allow for the

identification of factors that independently influence awareness and perception, controlling

for potential confounders.

o All statistical tests will be two-sided, and a p-value of less than 0.05 will be considered

statistically significant. The results will be presented in tables and figures, as appropriate,

to clearly illustrate the findings.